非体外及体外循环下左心室运动异常型室壁瘤切除术的临床疗效比较

目的比较非体外循环（off-pump）室壁瘤折叠术与体外循环（CPB）室壁瘤线形切除术治疗左心室运动异常型室壁瘤的临床疗效,以提高室壁瘤的治疗效果。方法2003年9月至2007年9月,手术治疗32例左心室前壁或心尖部运动异常型室壁瘤患者,其中男23例,女9例;年龄46～70岁,平均年龄63岁。根据手术中是否采用CPB,将32例患者分为两组,off-pump组（n=17）：室壁瘤范围占左心室的25%～37%,在off-pump下行室壁瘤折叠术;常规体外循环（on-pump）组（n=15）：室壁瘤范围占左心室的27%～40%,在常规CPB下行室壁瘤线形切除术。两组均同期行冠状动脉旁路移植术。术后采用超声心动图测定左心室容积及收缩功能等指标,并进行比较,以评价临床效果。结果两组均无手术死亡。off-pump组无围术期并发症,术后心功能分级（NYHA）较术前有明显改善（1.0±0.8级vs.2.9±0.3级,P=0.001）,左心室射血分数（LVEF）明显提高（41.0%±4.5%vs.36.4%±4.8%,P=0.035）,左心室收缩期末容积指数（LVESVI）明显减小（52.6±27.7ml/m^2vs.79.7±21.4ml/m^2,P=0.003）。随访17例,随访时间12～53个月,平均随访29个月,随访期间无死亡。1例患者术后1年因二尖瓣重度反流再次手术治疗,1例患者于术后3年发生充血性心力衰竭,LVEF31%,仍在观察中;其余患者临床效果良好。on-pump组围术期发生并发症3例（神经系统并发症2例、呼吸功能不全1例）,术后心功能分级较术前有明显改善（1.0±0.6级vs.3.1±0.9级,P=0.001）,LVEF较术前明显提高（42.3%±3.2%vs.35.6%±6.5%,P=0.023）,LVESVI较术前明显减小（49.3±22.6ml/m^2vs.81.3±25.0ml/m^2,P=0.003）。随访15例,随访时间12～60个月,平均随访35个月,随访期间无死亡,临床效果良好。两组间临床指标比较差异无统计学意义（P〉0.05）。结论在off-pump下行室壁瘤折叠术治疗左心室运动异常型室壁瘤,可有效地减少左心室容积,提高左心室?

Comparison of Clinic Results of Left Ventricular Dyskinetic Aneurysmectomy between Off-pump and On-pump

Objective To compare the clinic results between off-pump left ventricular（LV） aneurysm plication repair and on-pump LV linear aneurysmectomy for LV dyskinetic aneurysm （DA）,and to improve the curative effect of aneurysm. Methods From September 2003 to September 2007,32 patients with DA located in the anterior wall or apex of LV were operated. There were 23 male and 9 female aged 46-70 years with a mean age of 63 years. According to the procedure with or without cardiopulmonary bypass（CPB）,32 patients were divided into two groups：Off-pump group （n=17）,with the size of DA represented 25%-37% of left cavity. Patients in this group underwent off-pump LV aneurysm plication repair; On-pump group （n=15）,with the size of DA represented 27%-40% of left cavity. Patients in this group underwent on-pump LV linear aneurysmectomy. Coronary artery bypass grafting was the concomitant procedure in both groups. The clinic results were compared and evaluated via indexes such as left ventricular volume,systolic function etc which were determined by echocardiography. Results No operation death was found in both groups. In off-pump group,there was no perioperative complication. Postoperative cardiac function classification （NYHA） improved significantly （1.0±0.8 grade vs. 2.9±0.3 grade,P=0.001）,left ventricular ejection fraction（LVEF） improved significantly （41.0%±4.5% vs. 36.4%±4.8%,P=0.035）,and left ventricular end-systolic volume index （LVESVI） reduced significantly （52.6±27.7 ml/m^2 vs. 79.7±21.4 ml/m^2,P=0.003） compared with that before operation. Seventeen cases were followed up,and the follow-up time was 12-53 months with a mean time of 29 months. No death was found during following up. One case was reoperated 1 year after operation because of severe mitral valve regurgitation. One case had congestive heart failure 3 years after operation with a LVEF of 31% and still in observation. The other cases were fine. In on-pump group,there were 3 cases had perioperative complications ?